Section 2: Provide Individualised Support Services

Building upon a respectful, trusting relationship, counsellors strive to work jointly with clients to plan and prepare for counselling activities that are compatible with their individual plan as well as their preferences and strengths. As you have learned previously, these processes are carried out with the principles of person-centred, strengths-based, and active support in mind, supporting clients toward goals that promote their rights, independence, and autonomy. Before we look at the practical steps involved, it is vital to reiterate the importance of building positive trust with clients.

How to Build Trust and Relationships

This video describes how to build trust and relationships, based on the teachings of Dale Carnegie and his best-selling book ‘How to Win Friends and Influence People’.

watch

Establish a Respectful, Trusting Relationship

A respectful, trusting relationship between counsellors and their clients is key to providing effective support. While this seems like a fundamental principle that should not need to be repeated here, in practice, some beginner counsellors can struggle to keep this in mind when working with clients who have individualised plans. It is easy to slip into the trap of using the individualised plan as the basis of support and launching straight into providing support or interventions while missing the process of establishing positive rapport with the client and a working relationship that promotes trust.

Keep in mind that many clients with complex needs have had their rights and trust violated due to past trauma, negative experiences with services, and discrimination. Counsellors must take the time and effort to build safe and trusting relationships with clients and do so consistently throughout their work with clients.

Working collaboratively with the client is crucial. This aligns with the person-centred principles at the core of individualised support, whereby the client is seen as the ‘expert’ of their own lives and engaged as a collaborating partner in care planning and delivery. Particularly if clients have experienced violation or abuse of power in the past, such elements are even more critical for them to feel safe, empowered, and able to trust in their counsellor and the services.

The counsellor should not make decisions about support services without the client. Instead, the counsellor should work collaboratively with the client to help them identify actions and support activities that can be used to support the client’s requirements under the individualised plan. The client is the most important contributor to their individualised plan and should be in control of making decisions on how the plan is implemented and followed.

Building the Therapeutic Alliance

In this video, Dr. Judith Beck discusses the importance of building a strong connection, including using techniques such as self-disclosure. Answer the question that follows. 

watch

The way you interact with clients and their chosen support team, the type of information you provide, and the degree to which you enable clients to make decisions will have a significant impact on the trust in your client-counsellor relationship. Study the following helpful pointers on how you can develop and maintain client trust right from the initial session.

• Have an open discussion with the client about their individual needs and their order of priority. Always check that the information contained in the individualised plan is accurate and up to date.
• Spend time getting to know the client and respond to them as an individual (instead of focusing merely on their needs or issues), before proposing any interventions or support activities. Take note of the client’s preferences, strengths and abilities and incorporate these into the planning of counselling.
• Involve the client’s family and/or carer, as instructed by the plan or requested by the client, and treat them with the same respect and courtesy as the client. Remember, too, that some clients may prefer not to involve their family and/or carer.
• Be clear and transparent. Explain the rationale of your actions and processes and help clients know what to expect. If you need to gather information for risk screening, for instance, many clients find this process provocative and may not be readily open up to you without a trusting relationship built. It is important that you clearly explain the reasons for asking screening questions – this helps clients to predict what is upcoming – and normalise the process, emphasising that clients will not be coerced into providing information. For example, you may say, “I’m going to ask you a few questions that I ask every client to help me provide a safe service, however, you don’t have to answer any questions that you are not comfortable with.”
• Maintain consistency in practice. Inform clients about your services, explain boundaries in your client-worker relationship from the outset, and keep to it. It is also recommended to minimise any personnel changes as this can be particularly confusing for clients who may be engaged with multiple services at once. You may need to help clients understand that workers will be absent (e.g., sick or annual leave) at times and appropriate arrangements will be in place. Where possible, discuss with clients any changes to the service and offer support to aid the necessary transition.

emotional communication - right brain to right brain

In this video, Dr. Allan Schore describes the therapeutic alliance as a bond of emotional communication, right brain to right brain. Answer the questions that follow. 

watch

Review the Individualised Plan

When a counsellor receives a referral from a case manager or community services organisation, there is usually a referral letter or form with details relating to the person making the referral, the client’s personal details and relevant background information, reasons for the referral, and other areas of concern.

The referral may also be accompanied by a copy of the client’s individualised support plan as well as any specific instructions from the case manager concerning what the counsellor (and other service providers) needs to know in order to effectively support the client for the specific aspects outlined in the referral and their plan.

Whilst the format and name will vary, an individualised plan typically includes information regarding:

• the personal information of the client, including key relationships, their interests, who they are and what they can do 
• primary areas of concern and their level of impact
• the client’s goals
• the type of support required and/or services to be provided
• other necessary actions or activities required to meet goals
• the people responsible for the implementation
• key contacts, including people who will be involved in care and decision-making in relation to the individual
• specific support plans and/or progress notes
• referrals that have been made to other service providers or professionals
• review strategies and dates
• information about initiation of discharge or exit procedures.

The information contained in the individualised plan provides guidance on what supports a counsellor will be required to provide in their work with the client.

Typical reasons for counsellors to be engaged as part of the plan are to provide assistance with:

• working through specific concerns or issues
• developing support actions or activities to help the client achieve a particular goal
• developing particular skills/resources that address specific client needs, for example, learning skills and coping strategies to manage a mental health condition and improve daily living.

Importantly, each client’s circumstances will be different, and so is their individual plan. Counsellors will need to take the time to fully understand the requirements of the individualised plan and their role within it as well as the limits of these requirements.

Remember that in many cases the client will have a number of co-existing needs and their case manager may have developed an in-depth plan to ensure that each of the client’s needs were being supported by the most relevant professional. It can be confusing for the client (and a waste of resources) if the counsellor ‘doubles up’ on the support that the client is already receiving through another professional.

Hence, counsellors need to make sure that they follow this plan and work to provide the support within the scope determined. If there is any ambiguity or confusion, always check with the respective case manager or your supervisor/manager.

In some cases, however, there may not have been a case manager actively involved – the client may have chosen to self-manage their services; the client may have worked with other practitioners who incorporated short-term case-managing responsibilities in their role; or the client may have moved on from a time-limited case management service. Their plan may now require an update as it no longer reflects their current needs or circumstances.

It is therefore important to check and confirm the individualised plan details with the client (and their family/carers if appropriate) to make sure that the information is still relevant and accurate. Counsellors must never solely rely on the referral form or plan provided as client circumstances can change rapidly.

As mentioned in the previous section, work-role boundaries are an important consideration in providing individualised support. In cases whereby a counsellor has been requested to provide services or supports that are outside the scope of their own knowledge or skills then the counsellor must seek out the support of their workplace supervisor/manager for advice.

Just like any counselling work, it is important that the counsellor does not act outside their scope of knowledge and expertise because this would reduce the quality of the service provided and could expose the client, the counsellor, and the organisation to risk.

For example, if the individualised plan calls for the counsellor to use a counselling technique or approach that they are not trained in then the counsellor should not simply ‘give it a go’ and should instead refer the matter to their supervisor so that the client can receive the planned support.

Similarly, if the individualised plan calls for the counsellor to provide services that are outside their job role (or outside the scope of services provided within the organisation) then the counsellor should consult with their supervisor or discuss this with the original case manager so that they can make a more appropriate referral for this part of the individualised plan.

Contracting with the Client

As you have learned throughout your studies, counsellors undertake a contracting process with clients to set out a course for the counselling service and help them make an informed decision. Part of a counsellor’s role is to work with the client to develop and implement a specific counselling plan to help the client achieve their goals.

The nature of this role does not change when working with a client who has an individualised plan – however, there will be a need to consider the counselling goal(s) with reference to the details in the plan (e.g., what the client’s short- and long-term goals are).

Usually, the focus of the counselling work has already been determined by the individualised plan, as there should be a clear rationale for why the client requires psychosocial or mental health support. With reference to the information outlined in the referral form and plan, the counsellor may ask, “Your referral indicates that ______ and that you are interested in working on __________, is that right?”. This provides the client with an opportunity to discuss the individualised plan and discuss any inconsistencies or issues before the counselling process begins.

If the client identifies any issues with the individualised plan (e.g., it includes goals they do not wish to work on, or the client wishes to add goals to the plan) then the counsellor will need to contact the original case manager or equivalent service to have it amended.

For instance, one of Julian’s goals is to improve engagement with the community. The counselling service may have been engaged to help him with improving self-esteem and social skills. Of course, that does not mean that Julian’s counsellor should make any assumptions about what he wants to achieve out of counselling or jump straight into the counselling without establishing the counselling relationship and process.

Under the banner of improving engagement with the community, the counsellor must work with Julian to break the plan down to aspects that he would like to use counselling for and determine how such a process can be personalised to his preferences and needs as much as possible within this context. When working with a client with an individualised plan in place it is important for counsellors to discuss the plan that they have received with the client and confirm its details. This not only helps to ensure that the counselling relationship maintains an appropriate focus, but it can also help with the process of developing initial rapport.

A Note on Working with the Client’s Support Network

In many cases, clients with individualised plans have a complex range of needs and might be supported in their individual self-care by family and carers. Where appropriate, counsellors should also discuss and confirm the individualised plan’s details with the client’s family and carers.

This is particularly important when they have been actively engaged in decision-making (e.g., when working with a young client, you may need consent and information from the client’s guardian or parent) and/or implementation of the client’s plan (e.g., counselling will be provided at the client’s home which they share with their family; a client with intellectual disability relies on their support person for communication). In addition, they may be able to provide useful information about the client’s daily living to help you tailor the counselling provided.

Counsellors can demonstrate respect for the client’s family and carers as part of the support team by:

• including them when appropriate, to the extent as agreed with the client
• facilitating discussions with the family and/or carers involved about the client’s support needs
• acknowledging the contribution already made by the family member or carer in supporting the client
• encouraging and assisting the family and/or carers to help the client engage in relevant support activities outside the counselling sessions
• providing feedback to family and/or carers about the client’s progress and including them in celebrating milestones or the client achieving a personal goal.

It is also important to remember that the individualised plan does not replace the contracting process.

Counsellors will still need to complete all the steps relevant to contracting as per their organisational requirements, which may include:

• providing information about the counselling organisation and the counselling approach used
• informing the client of organisational requirements such as payment schedules, cancellation policies and termination procedures
• making sure that the client is aware of record-keeping processes and the limits of confidentiality
• making sure the client is aware of their rights and responsibilities
• making sure that the client is aware of complaints procedures and what to do if they would like to provide any feedback.

As you have learned, counsellors will typically discuss this information with clients in the initial contracting stage of counselling and have clients confirm their understanding by signing a counselling contract. This contract should document all of this key information and every client should be provided with their own copy.

Additionally, in cases in which the client’s family/carers are to be involved in the supports provided under the individualised plan, the counsellor should also ensure that they are made aware of all of the points discussed and that they agree to participate.

Prepare for Support Activities

The counselling goals and activities developed should support a client’s individualised plan and align with the specific goals they hope to achieve. It should also reflect the client’s strengths, preferences, and abilities while adhering to any relevant organisational policies, protocols and procedures. A counsellor often begins by exploring a client’s interests, preferences, and strengths, such as by considering:

• What is important to them?
• What are their existing strengths and abilities?
• What do they enjoy?
• What are their individual circumstances, including anything that may help or hinder the client from achieving their goals?
• What are their personal beliefs and values?
• What is the likely impact of the client achieving their goals?
• How would they like to receive support?
• What barriers do they face when engaging in support/achieving their goals?
• How will the client’s physical and/or psychological well-being impact the counselling process or support activities?

Remember that providing individualised support is to tailor services to what the person needs. From a person-centred perspective, clients are your best source of information, as they are the ‘experts’ of themselves. As such, these questions are best explored in conjunction with the client, in order to encourage them to make informed decisions on the counselling activities they will be engaging in.

The following extract provides additional tips on identifying and preparing support activities with clients:

As you can see, collaboration is a vital principle underpinning individualised support planning and delivery. Throughout the preparation and provision of counselling, counsellors must work jointly with clients to determine how to make best use of the counselling service in relation to their goals. At all times, you should be working from an approach that supports and/or improves the client's independence and self-determination in making decisions about their living.

With that in mind, it is also your responsibility to make sure that the counselling activities planned are not beyond what you (or your organisation) can offer. For example, it may be the client’s preference to have counselling sessions in a public space such as a fast-food outlet, however, this means that you are unlikely to keep the session private and confidential which is against your organisational requirements.

This may be a simplistic example, but it demonstrates the importance for counsellors to make sure they are working within organisational requirements while supporting the client to have their say about how counselling should proceed.

Apart from making sure that you work within organisational requirements, effective individualised service planning and delivery also require counsellors to balance between duty of care and dignity of risk, with respect to individual differences. Let’s take a closer look at these two aspects.

Preparing for support activities and providing support

Study the following steps to ensure you understand the process involved in preparing for support activities according to your client's individualised plan, preferences and organisation policies, protocols, and procedures, and then, finally providing the support within the same framework.

1. Client-counsellor collaboration: Engage the client in collaborative discussions, ensuring their preferences are considered.
2. Communication of organisational policies, protocols, and procedures: Clearly commuicate the organisation's policies, protocols, and procedures.
3. Informed consent process: Facilitate a comprehensive informed consent process, discussing and documenting the client's preferences within the parameters defined by organisational policies, protocols and procedures, ensuring the client's understanding and agreement.
4. Integration of preferences into support plan: Collaborate with the client to incorporate their preferences into an individualised support plan, ensuring alignment with the organisation's policies, protocols and procedures.
5. Regular check-ins: Schedule regular check-ins with the client to assess the impact of their preferences and adjust the approach as needed, considering both client preferences and adherence to organisational requirements.
6. Documentation of client preferences: Maintain detailed documentation of the client's preferences, ensuring records align with organisational policies, protocols and procedures.
7. Supervision and consultation: Seek supervision when faced with ethical dilemmas or situations that may breach boundary considerations.
8. Client education: Educate the client on organisational policies, protocols, and procedures, fostering client understanding of how their preferences can be integrated while respecting parameters. This educational approach promotes collaboration while upholding organisational requirements.

Duty Of Care and Dignity of Risk

Duty of care and dignity of risk principles are both key considerations when it comes to working safely and appropriately with clients. Many find it challenging to depict the relationship between these two; the following extract offers a useful perspective in understanding them:

In other words, duty of care is a legal responsibility to “do no harm” put upon service providers so that they are held accountable for the client’s safety and well-being where relevant. This principle is set out to protect clients, instead of to prevent clients from exercising their autonomy and rights. Going overboard with duty of care may constitute an ‘overprotection’ of clients (e.g., refraining clients from making any decisions).

Dignity of risk, on the other hand, focuses on supporting clients’ rights – to learn, make mistakes, take risks, and maintain freedom. However, if the dignity of risk principle is taken overboard (e.g., blindly supporting all decisions a client makes), it may constitute ‘negligence’ on the practitioner.

When planning and delivering counselling activities, it is important for counsellors to support the client’s dignity of risk as much as possible with duty of care in mind. In practice, you would want to encourage clients to make decisions where safe and possible, even if these decisions come with a potential risk. However, where this risk is severe – such as likely to cause death or permanent disability – you have a responsibility to step in and exercise duty of care.

Depending on the scenario, it may be appropriate for you to discuss the risks with the client, and help them develop strategies to promote safety or discourage the decision. In most cases, you’ll be able to find relevant guidelines from your organisational policies and procedures.

Respect Individual Differences

It is also vital to respect the client’s dignity and privacy throughout your work with the client by respecting individual differences. Every client is unique in terms of their age, cultural background, (dis)abilities, interests, values, and life circumstances – these factors can influence the way clients perceive the appropriateness of support and counsellors may be required to alter their approach to service delivery to ensure that it is culturally safe for the client.

Some clients may prefer to have a maximum level of independence from the start, whereas others may prefer a scaffolded approach to support. It is important to adjust your work approach to suit the client (within the limits of your organisational requirements, of course) to demonstrate a maximum level of respect.

In most cases, the client’s individualised plan will contain information about the client (e.g., who they are, and what is important for them) which helps gauge things you need to know in order to work respectfully.

For example, you may find information about the following aspects:

Each client will have a different understanding of what privacy is, too. For example, if you are entering the client’s home to provide counselling support, you must check with clients and make sure you are not violating their personal space and items and that there is somewhere suitable for providing service with a maximum level of privacy for the client (and the people they reside with). Some clients may refuse to provide certain personal information if they think it is too private; as such it is recommended that you clearly explain why such information is sought and how it will be kept privately to reassure your clients.

To support self-determination and autonomy, always make sure that you work with clients in a way that provides the maximum level of dignity and privacy where possible. Make sure clients are clearly informed about the details of services they will be engaged in, and proactively encourage clients to provide feedback on any concerns they may have. Sometimes, it means adjusting and being innovative in the way you engage clients in setting up appropriate boundaries in your working relationship.

Following is a diagram from a Safe Support tool (WorkSafe Victoria, 2020) that can be used with clients to discuss and agree on what respectful and inclusive in-home support service looks like. Clients, family members and workers can add to the list and sign at the end of the document together, and leave this in a visible place for future reference – a full copy is available as Reading I in your Readings.

Please note: This section titled 'Respect and Inclusion', found in Reading I, can also be reviewed by accessing Safe Support (pdf)

When providing individualised support, you are likely to come across situations where you may need to offer practical support and assistance to the clients, in alternative settings such as the client’s home. In these cases, it is important that you monitor for potential risks and make sure that you always act in accordance with your organisational policies, protocols, and procedures.

Traditionally, the counsellor’s role is mainly focused on providing psychosocial support to clients. However, when supporting clients with complex needs, counsellors (or other practitioners who may provide counselling as part of their role) are more likely to work in alternative service delivery models, such as providing counselling at a client’s home, in outreach settings, or at a residential care facility.

They are also likely to support clients with developing and maintaining life skills and using certain tools or equipment to achieve goals and increase independence. As such, it is important that we consider how to provide practical assistance, where necessary, in a safe way to complement the support counsellors typically provide.

In various contexts, counsellors may use different strategies to assist clients with skill development and equipment use.

Often, the choice of strategies will depend on the client's capacity and their circumstances, which may include:

• Role-modelling: For example, counsellors may use positive, respectful language with clients as a way of encouraging them to learn better communication strategies.
• Demonstration: Counsellors may demonstrate how to use a tool in front of the client so that they can repeat similar chains of actions.
• Role-plays: This involves rehearsing in simulated scenarios during counselling to increase the chance of the client implementing such skills or using such tools in real-life situations.

Assembling Equipment as and When Required

In some cases, the client will have individual needs that require access to specialist equipment. The client’s individualised plan should identify any facilities, equipment, or resources required by the client to actively engage in the counselling process, perform a certain task, or achieve an individual goal. If the client does require any specific equipment or supports, it may be within your responsibility to facilitate the client’s access to these.

Where applicable, you must ensure that you know how to safely use different types of equipment before using it to support the client, making sure that it is clean, and knowing how to check if the equipment is functioning correctly.

This list is not exhaustive, as ‘equipment’ can also include a wide range of virtual or digital tools nowadays. Consider, for example, when providing online counselling services, there may be a need for the counsellor to assist the client with setting up and accessing the virtual secure platform that will be used. If clients are interested in practicing mindfulness skills and would like support with setting up a meditation app on their phone, counsellors may step in to help them install and access it appropriately.

It is often useful to leave clients with clear instructions (e.g., a step-by-step guide) or visual aids (e.g., a diagram) on how to operate this equipment. Families or carers may also be engaged to help make sure clients are able to access and operate equipment in a safe and appropriate way.

On the other hand, counsellors who work in specialist services may need to handle or educate clients to use certain tools for their wellbeing. For instance, a crisis counsellor who supports people experiencing DFV may assist clients with setting up safety features as part of safety planning. Clients may learn to set limits to access to their social media information, set up a DFV safety app on smartphones (some function as duress alarms, others assist in recording evidence) or increase the security of their passwords.

Another example could be an alcohol and other drugs counsellor working in supervised injecting facilities (i.e., dedicated spaces where illicit drugs can be used under the supervision of trained workers) who may support clients with the safe use and disposal of injecting equipment.

Importantly, do not use equipment or aids that you have not been permitted, trained, or qualified to use as you may cause harm or injury to yourself, or to the person you are supporting – always check and follow the protocols of your organisation. If you are unsure about how to use any equipment or aids, ask your supervisor or relevant case manager for assistance. Specialist advice should be recommended to determine what equipment is best suited to an individual’s needs, and where it can be obtained to support a person in improving their functional independence.

Case Study

Mae is a counsellor who is working with a client, Benny, who benefits from visual aids during sessions due to their learning style and communication preferences.

She takes the following steps to ensure Benny's needs and preferences are being met during a session:

1. Identify client needs: Before the counselling session, review the individualised plan to understand the client's preferences and requirements. In this case, the plan highlights the client's inclination towards visual learning and the use of supportive materials during discussions.
2. Select appropriate visual aids: mso-ligatures:none;mso-fareast-language:EN-AU"> Based on the client's needs, gather relevant visual aids such as diagrams, charts, or written materials that can enhance the counselling process. Ensure that the selected aids align with the session's objectives and contribute positively to the client's understanding and engagement.
3. Prepare the counselling space: mso-ligatures:none;mso-fareast-language:EN-AU"> Arrange the counselling space in a manner that accommodates the use of visual aids. This may involve setting up a flip chart, ensuring proper lighting for visibility, and organising seating to facilitate clear communication. Consider factors such as the client's comfort and the confidentiality of the information displayed.
4. Test and familiarise with equipment: If using electronic equipment, such as a projector or screen, conduct a pre-session test to ensure functionality. Familiarise yourself with the equipment's operation to avoid disruptions during the counselling session. This step ensures that the technology serves its purpose seamlessly.
5. Establish consistent procedures: mso-ligatures:none;mso-fareast-language:EN-AU"> Develop a routine for assembling and disassembling equipment before and after each session. Consistency in these procedures not only ensures efficiency but also contributes to the creation of a safe and predictable therapeutic space for the client.
6. Facilitate client engagement:mso-ligatures: none;mso-fareast-language:EN-AU"> During the session, introduce the visual aids as planned, explaining their relevance to the counselling process. Encourage the client to interact with the materials, fostering a collaborative and engaging environment that aligns with the client's individualised plan.

By following these steps, counsellors demonstrate their ability to assemble equipment in accordance with established procedures and the client's individualised plan, showcasing a personalised and effective approach to the counselling process.

Assist to Maintain a Safe and Healthy Environment

A client’s environment can impact their well-being in many ways. In some cases, clients with complex needs may not have a beneficial support network and/or an appropriate living environment that facilitates their well-being goals. This may also exacerbate risk issues for the client and affect service delivery when not appropriately addressed.

If a counsellor has concerns that a client is living in an unsafe or unhealthy environment, they should seek the client’s permission to raise this with a case manager so that the client can get access to relevant support. In some cases, counsellors may also support clients to maintain a safe and healthy environment through interventions and skills development.

Fundamentally, counsellors have a responsibility to make sure that the counselling environment is safe for both themselves and the client. Depending on the type of services you provide, and the organisation you work for, counselling services may take place in a range of settings, such as a private clinic, doctor’s surgery, hospital, youth centre, aged care facility, training centre, or in the person’s home or workplace.

As mentioned in the previous section, you will need to consult the individualised plan, and the client and/or family/carer, to identify any potential physical or psychological hazards that could cause harm to you or the client, assess the likelihood and potential consequences of harm, and eliminate or reduce the risk as much as possible. The following extract provides a few examples of risk situations that counsellors may encounter.

At all times, it is critical that you adhere to organisational policies, protocols and procedures relating to work health and safety (WHS) in all counselling settings, including any risk identification, management, and incident reporting requirements. These guidelines will be underpinned by the relevant WHS legislation in your state or territory. If there are any aspects of the individualised plan that you think may pose a WHS risk, you should raise this issue with your supervisor or the relevant case manager immediately.

Remember that physical safety and health are not the only focus here. As a counsellor, your work is also largely relevant to helping the client maintain their emotional health and safety. Depending on the client’s circumstances and goals, you may work with them to develop and improve interpersonal and emotional regulation skills in order to maintain a positive environment that facilitates safety and health.

Where there have been DFV-relevant concerns, counsellors may need to continuously assess and provide support to make sure clients have access to safe spaces and have strategies to enhance their safety. For instance, if a client is still living with or connected with the person using violence, counsellors may assist clients with developing skills and strategies to increase their safety at home.

Case Study

Karenne is a single parent with two children. Her youngest child has severe disabilities and requires intensive support. Whilst there are respite services in place to assist, Karenne feels really exhausted in managing her daily duties. She feels that she never gets a break, and her house is always in a mess, which adds to her stress. There are also growing concerns for the misbehaviours of her eldest child whose needs are often neglected. They fight a lot and can get quite aggressive with each other sometimes. Karenne says that whilst she wants to get on top of her parenting, her exhaustion leads her to yell and scream at her eldest child, which exacerbates the situation. She even admits to using drugs from her friend to numb herself on a couple of occasions when it seemed impossible to get through.

Another important aspect of health and safety is the cleanliness of the environment. Everyone has a different definition of what a clean and comfortable environment looks like – however, providing service in an environment that may have bodily fluids, drugs and alcohol, mould or other hazardous material constitutes a significant risk to the counsellor and the client.

Moreover, a low-lit, noisy, and disorganised environment can be extremely uncomfortable, and sometimes triggering for people who have experienced trauma. As such, maintaining a clean and comfortable environment is important for the well-being of both counsellor and client.

Counsellors should also familiarise themselves with the relevant infection control policies and procedures of their workplace. While counselling is not typically perceived to be a high-risk environment for hazardous biological material, the spread of colds and flu is common, and there is a possibility of a client injuring themselves and the counsellor being required to provide first aid.

Familiarising yourself with infection control policies and procedures can help reduce the opportunity for the spread of infections to occur. Rigorous infection control practices emphasise infection surveillance, isolation practices, handwashing, and sterile techniques.

Inevitably, a key part of supporting clients to maintain a safe and healthy environment is relevant to the counsellors’ responsibilities to identify and respond to various risk situations.

As a counsellor, you will need to identify and respond to situations of potential or actual risk within the scope of your role according to the individualised plan, and report to your supervisor or the case manager as required. WHS laws in each state and territory impose a duty of care on employers to provide a safe workplace, adequate resources to ensure the workplace is safe and that every effort has been made to control risks, and clearly defined WHS responsibilities to ensure everyone in the workplace is accountable.

Your organisation’s WHS policies and protocols will outline your role in identifying, responding to, and reporting risks. The individualised plan will also identify potential risk areas associated with a particular client and suggest how you can mitigate such risks by ensuring the counselling setting is safe for your client. Nevertheless, policies may not cover every possible situation of risk; hence, you must be vigilant about prioritising the safety of yourself and the client, and seek advice and additional support as soon as practicable.

Identifying Risks

As a counsellor, you should observe any changes in your client's or the counselling environment that could pose a potential risk. This includes:

• recognising any changes in client behaviour that are uncharacteristic
• identifying client behaviours or triggers that have not been included in the individualised plan
• being aware of any changes to the client’s personal circumstances
• being alert to any changes in the counselling environment that may indicate new or different hazards or levels of risk.

Suicide Assessment by Counselor Supervisor Not Familiar with Client

This video features a counselling role-play session that demonstrates a suicide assessment of a client (played by an actress) by a counsellor supervisor who is not familiar with the client’s history. Answer the questions that follow. 

watch

Responding to Risks

When you identify an actual or potential risk, it is important that you respond immediately to minimise the probability of harm or injury occurring. Your organisation will have a formal process that you should follow to report and follow up on risks. The individualised plan will also identify who should be contacted, or what procedures should be followed if a risk or crisis situation occurs.

For example, you could respond to a risk situation by:

• contacting emergency services, such as the police, ambulance, fire brigade, or mental health services
• following your organisation’s evacuation plan or lock-down procedures to move yourself or others away from a client who is behaving aggressively
• removing the hazard immediately, such as cleaning up a spill
• requesting support to intervene when a client is behaving inappropriately
• implementing a temporary response, such as removing the client from an unsafe counselling setting
• reviewing and making changes to an individualised plan to mitigate a potential risk to the client.

As a counsellor, you will often work one-on-one with your clients and may not have access to immediate assistance should a risk situation occur. For this reason, a considerable amount of problem-solving will be required on your part to ensure the situation can be temporarily controlled before seeking further help. You must always follow your organisation’s WHS policies and protocols that exist to protect you, and other support workers, in a range of counselling settings.

How to Assess for Suicide: Role Play Counseling

This video features a counselling role-play session that demonstrates a suicide assessment. Answer the questions that follow. 

watch

Reporting Risks

If you identify an actual or potential risk in your workplace, your supervisor or manager will most likely be your first point of contact to implement an appropriate risk management strategy – however, if they are not available, you should approach the next available staff for additional support.

If the risk directly relates to a client who has been referred to your service, you may need to contact the case manager to formally report the incident, and/or review the client’s individualised plan. When reporting risk situations ensure you use the correct forms or templates required by your organisation or by the case management agency implementing the individualised plan.

The following case study demonstrates how a counsellor could identify and respond to situations of risk and report the risk to their supervisor.

Case Study

Danielle provides in-home counselling services and support to parents of young children who have experienced family violence in the home. Each client has been carefully assessed by a case manager to ensure the home environment is a safe and practical counselling setting for both Danielle and the people she supports.

One of Danielle’s clients is Esther, a 21-year-old mother of two who has recently fled her family home after being physically abused by her ex-partner. Esther is currently living in a crisis accommodation centre for single mothers that is securely monitored. Esther’s two young children are in her care at all times. During one of their counselling sessions, Esther tells Danielle that her ex-partner has been sending her abusive text messages to a phone number she thought was private. Esther is afraid that he will find out where she lives and attempt to cause her harm.

What did Danielle do?

Danielle immediately contacted her supervisor to report the risks identified, who advised that she liaise with Esther’s case manager to discuss further strategies to improve Esther's and her children’s safety.

With Esther’s consent, the case manager contacted the police to notify them that Esther’s ex-partner has breached the conditions of a Family Violence Order (FVO) Esther holds against him. That same day, Danielle spends time recording the situation in Esther’s individualised plan and continues speaking to the case manager about how Esther and her children’s safety could be further assured.

Additional support and referrals are often appropriate and recommended for managing risk situations. There are also other circumstances whereby referral is required because it is no longer possible or appropriate for you to continue working with the clients.

During the process of working with a client, it may sometimes become apparent to you that it is no longer appropriate or possible for you to provide support. This includes situations where:

• the client’s behaviour, needs, preferences, abilities, or circumstances have changed
• the support needs are beyond your own skills, knowledge, or expertise
• the support needs fall outside of your organisation’s scope of service or catchment
• the client disagrees with an aspect of their individualised plan and requests for it to be changed
• severe risk issues have been identified and more specific support is required
• your professional capacity or personal circumstances have changed.

For example, consider the following scenarios:

• A client has developed a mental illness that was not identified in their individualised plan. In this case, you will need to speak to their case manager about referring the issue to a mental health specialist or doctor for appropriate treatment.
• When you attend the client’s home for counselling, the client appears intoxicated and becomes verbally abusive to you. You explain to the client that it is not safe nor possible to offer service and leave after making sure they are not at risk of safety. You immediately call your supervisor to report the situation and document the incident.
• A client tells you that they no longer have the support of a family member or carer who was identified in the individualised plan; you should speak to the case manager to organise additional in-home care and support so that the client can continue to live independently.
• The client’s individualised plan includes a referral to counselling services, but the client is reluctant to participate. You will need to seek assistance from your supervisor on what you could do to encourage the client’s cooperation or reassess the appropriateness of counselling for the client.
• If you consider that a proposed intervention contained in the individualised plan is not appropriate, you will need to seek assistance from the case manager to modify or change the plan so that support activities meet the client’s individual needs and preferences.

It is important that you willingly seek assistance when it is no longer safe or possible for you to provide appropriate support according to the client’s individualised plan. Remember that your role is to work within the designated scope of the individualised plan, and there may be issues that are better dealt with by other service providers who are already part of the team supporting this client. Always consult your supervisor, as well as the relevant case manager, to determine whether further referral is required and to make sure clients are still receiving the level of support they need.

The following case study provides an overview on the process of providing individualised counselling support to clients with complex needs.

Case Study

Bethany is a qualified counsellor at an organisation providing counselling services to people of all ages, for a range of personal issues. Bethany has expert knowledge and additional skills to provide counselling support to people with limited verbal skills, and to people with mild and moderate intellectual disabilities. Bethany sometimes uses communication aids to facilitate learning and interaction between herself and her clients. Bethany is committed to providing her clients with a high-quality, person-centred service.

Lucy is 28 years old and has a hearing impairment. She has been referred to Bethany’s counselling practice by Sandra, a case manager from a disability services and support organisation. Sandra provides case management and specialist services to people with a disability. She has been working with Lucy to help her plan and find the support she needs to live independently, gain meaningful employment, and actively participate in the community.

Sandra sends Bethany a referral letter for Lucy and a copy of Lucy’s individualised plan. The referral instructs Bethany to provide emotional support and prepare a range of activities that will help Lucy achieve her personal goals. Following is a copy of Lucy’s individualised plan.

In this section, you learned about the processes involved in providing individualised support to clients. This includes establishing a trusting relationship with clients, working collaboratively with them in planning and preparing support activities in conjunction with individualised plans, and providing practical support and assistance where applicable. You also learn about identifying and appropriately responding to situations of risk, and how to seek assistance and refer when it becomes unsafe or inappropriate to provide support.

1. Government of South Australia. (2014). Community workers: Work health and safety guidelines. (4th ed.). https://www.safework.sa.gov.au/industry/health-and-community-care/home-support-and-community-care
2. LifeTec. (n.d.). What is Assistive Technology? Retrieved July 5, 2022, from https://lifetec.org.au/education/what-is-assistive-technology?pageID=198&main=198&sub=0.
3. Summer Foundation. (2021). Good practice guide: A practice guide for NDIS support coordinators working with people with complex support needs. https://www.summerfoundation.org.au/wp-content/uploads/2021/12/UPSKILL-Good-Practice-Guide-.pdf
4. Willoughby, K. (2014). Supporting Skill Development of Adults with Intellectual Disabilities within a Day Service Environment. http://www.cddh.monash.org/assets/supporting-skill-development-of-adults-with-intellectual-disabilities-within-a-day-service-environment-2014.pdf
5. WorkSafe Victoria. (2020). Safe support tool. https://www.worksafe.vic.gov.au/resources/safe-support-tool